The Terry Project on CiTR #41: The Four Pillars Revisited (Part 1 of 5)

Prevention, treatment, harm reduction, and enforcement—Vancouver’s four pillars. It’s the most progressive drug plan of any city in North America. But its authors fear that the pillars are crumbling. This is part one of the Four Pillars Revisited. Our 5-part season-opener, produced in partnership with The Tyee, and syndicated at the University of Victoria and Simon Fraser University in Burnaby.

Bud Osborne was the unofficial poet of Vancouver’s Downtown East Side, and he said a ‘genocide’ was happening to his neighbourhood. Soaring HIV, Hep C, and overdose rates killed 100s of people each year throughout the 1990s. He convinced the then-mayor Larry Campbell that opening up a supervised injection site would be a good idea. And, a few months after becoming mayor, Campbell oversaw the opening of Insite–North America’s first state-sanctioned supervised injection site.

Researchers and public health officials call this ‘harm reduction.’ It’s a simple idea, but it profoundly transformed the way Vancouver looks at people who are drug dependent; they are not criminals that ought to be punished, but patients that ought to be treated.

In Vancouver, these ideas are found in an 85-page document called The Four Pillars. Passed in 2001, it included 36 recommendations for a more progressive way to deal with Vancouver’s drug crisis. It was the most bold drug policy of any city in North America.

Where do those four pillars stand today? Some of the people who helped erect them fear the city may be failing to maintain what’s been built. This is the first of a 5-part series. Today’s episode is an introduction to the Four Pillars. In the coming weeks, this series will investigate each of the pillars – prevention, treatment, harm reduction and enforcement.

Dr. John Blatherwick was the Chief Medical Health Officer for Vancouver Coastal Health from 1984 to 2007. Today he’s known as a pioneer for public health–a pragmatist that fought against homophobia and moral absolutism. In 1985, Blatherwick opened one of North America’s first needle exchanges to prevent the spread of communicable diseases among drug users. In this special extended interview, Gordon Katic and Sam Fenn speak with Dr. Blatherwick about Vancouver’s HIV/AIDS epidemic. Blatherwick talks about his relationship with the media, the politics of health in BC and why he thinks things are heading in the wrong direction.

Bonus Material: what is the Four Pillars, how did it happen, what did it do, and is it enough?

“A Framework for Action is an urgent appeal to all levels of government, the many committed non-government agencies, our law enforcement agencies, our criminal justice system, and health care professionals to rally together to develop and implement a coordinated, comprehensive framework for action that will address the problem of substance misuse in the city of Vancouver – one that balances public order and public health and is based on four pillars; prevention, treatment, enforcement and harm reduction.” -Donald MacPherson

“There was a villain in the story. However the villain was not a person but conventionality itself, and the fear of what might happen if popular thinking about drug policy was challenged.” – Dan Small, Anita Palepu and Mark W. Tyndall

“Fix: The Story of An Addicted City,” a superb documentary about the passing of The Four Pillars.

“Speaking truth to power, the role of drug users in influencing municipal drug policy [PDF – UBC only link],” an article in Drug Policy by Bud Osborne and Will Small that argues what happened in the DTES was “tantamount to ‘genocide,” and “Harm Reduction by a ‘user-run organization: A case study of the Vancouver Area Network of Drug Users (VANDU) [PDF – UBC only link]“, an article in the same journal that highlights the role of activism in making drug reform happen.

“Something needed to be done to bring this cry of suffering and pain into the public realm. Bringing the voice of the users themselves and the cry of the pain, the anguish, the suffering, as loudly and broadly as possible finally brought a response. – Bud Osborne and Will Small”

Further Reading: Is the Four Pillars Enough?

“Harm reduction through a social justice lens [PDF – UBC only link],” an article by Bernadette Pauly in Drug Policy that introduces key concepts in an social justice approach to the issue, which typically argues that The Four Pillars is not enough, and “As strong as the weakest pillar: Harm Reduction, law enforcement and human rights [PDF – UBC only link],” by Jonathan Cohen and Joanne Csete, which argues that The Four Pillars was pragmatic compromise, and Vancouver needed a human rights response, not a biomedical response.

‘The document may be described as more political than evidence-based. It is preoccupied with achieving “consensus” without reflecting on whether the consensus result is necessarily the best one for drug users and their communities.” –Jonathan Cohen and Joanne Csete

“Beyond Vancouver’s ‘Four Pillars [PDF – UBC only link],'” an article by Bruce K. Alexander that echoes Plato’s idea that addiction is a lifestyle used to fill an agonizing social void. Alexander argues that we must go much further than The Four Pillars, and to do that we need to question how our economic system dislocates and marginalizes people.

“At present, there is no reason to think that the prevalence of addiction to drugs, alcohol or anything else has decreased under the Four-Pillars regime.” – Bruce K. Alexander

Gordon Katic (@gordonkatic) has been student coordinator for the Terry Project for over two years, and in that time started BARtalk, and the Terry Project on CiTR 101.9FM. A former Ubyssey columnist, and now a student at the UBC Graduate School of Journalism, Gordon is trying to use journalism to tell important stories about global issues.